Provider Demographics
NPI:1053613240
Name:SMITH, CLARISSA FELLS
Entity type:Individual
Prefix:MISS
First Name:CLARISSA
Middle Name:FELLS
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CLARISSA
Other - Middle Name:FELLS
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, MA, OTR/L
Mailing Address - Street 1:8198 CASTLEHILL RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-7232
Mailing Address - Country:US
Mailing Address - Phone:205-243-3257
Mailing Address - Fax:205-994-2251
Practice Address - Street 1:8198 CASTLEHILL RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-7232
Practice Address - Country:US
Practice Address - Phone:205-243-3257
Practice Address - Fax:205-994-2251
Is Sole Proprietor?:No
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0318225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist